A Rare Neurosurgical Challenge: Brain Meningioma with Epidural Hematoma

Brain meningiomas are predominantly benign extracranial brain tumors arising from the arachnoid cells of the meninges. According to their anatomical localization and trapping site, they are arranged in different groups. The World Health Organization categorizes meningiomas according to their malignancy and classifies them into three types, each of which includes a different histological type of meningioma. The vast majority of meningiomas are benign and recurrence depends largely on surgical resection and subsequent radiotherapy. The main methods in the diagnosis of central nervous system meningiomas are computed axial tomography and magnetic resonance imaging enhanced with contrast material, the radiological hallmarks of meningiomas being the presence of homogeneous filling of the tumor with contrast and a „dural tail“, which are among the key pathognomonic features of an extraaxial tumor. Surgical treatment is rarely challenging, except in cases of a richly vascularized tumor, extension of the latter to venous sinuses, and atypical localization of meningiomas. Achieving a Simpson grade I or II resection significantly reduces the risk of tumor recurrence. A rare type of complication is postoperative epidural hematoma at the site of the performed craniotomy or at a different site from it, which leads to a rapid and progressive deterioration of the general brain condition. We present a case of a 46-year-old woman with invasive breast cancer and meningothelial meningioma located frontally (parasagittally) on the left with marked compression of the underlying brain parenchyma, leading to general cerebral and focal neurological symptomatology. Simpson grade I removal of the meningioma was performed. Postoperatively, the patient developed a state of disseminated intravascular coagulopathy, with worsening of the general cerebral condition to coma, from the development of a left parietotemporal epidural hematoma. Timely diagnosis and operative treatment led to a favorable outcome from the complications that developed.